OCTH 256 - Middle Aged Adults Midterm 1

rheumatoid arthritis (RA)

• a chronic inflammatory condition where the immune system attacks the lining of all joints in the body (autoimmune)

• causing synovitis (inflammation of the synovial membrane)

RA joint changes

• swan neck deformity

• boutonniere deformity

• ulnar drift

• subluxation by volar or dorsal displacement

osteoarthritis (OA)

a degenerative and non-inflammatory joint disease that causes joints to break down due to “wear and tear”

Herberden’s node

• in pt w/ OA

• nodule on the DIP joint

Bouchard’s node

• in pt w/ OA

• nodule on PIP joint

OA joint changes

• gelling (stiffness after periods of inactivity)

• nodules in DIP, PIP, MCP

• bone spurs

• cartilage softening

RA symptoms

• pain

• swelling

• morning stiffness > 1hr

• symmetrical

OA symptoms

• no swelling

• morning stiffness < 1hr or from inactivity

• nodules are first painful/tender then hard and painless

• minimal/local inflammation

• crepitus (crackling, popping, clicking sounds)

• asymmetrical

RA onset

any time in life and rapid progression (weeks to months)

OA onset

typically later in life and slow progression (years)

RA classification

at least 4

• morning stifness

• arthritis of 3 or more joints

• arthritis of hands joints

• symmetrical nodules

• rheumatoid nodules

• serum rheumatoid factor

• radiographic changes

RA functional issues

• weak grip

• difficulty dressing, meal prep, working, writingOA

OA functional issues

• hand pain

• reduced ROM

• difficulty with stairs

• completing household tasks

Acute inflammation treatment objectives

• decrease pain and inflammation

• maintain ROM, strength, and endurance

Subacute inflammation treatment objectives

• reduce pain and inflammation

• maintain ROM, strength, endurance

Chronic active inflammation treatment objectives

• decrease pain and inflammation

• increase or maintain ROM

• increase strength and endurance

Chronic inactive inflammatory treatment objectives

• decrease pain

• increase or maintain ROM

• increase strength and endurance

what is joint protection

• a self-management approach taught to pt w/ RA or OA

• aims to maintain functional ability through changing/adapting work methods and movement patterns of affected joints

• changing habits can help reduce pain, inflammation, and stress on joints

principles of joint protection

• use in most stable position

• avoid external or mechanical stress towards position of deformity

• evenly distribute carrying load

• use largest joint/muscle for task

• avoid stress of small joints

• use leverage to gain force with less effort

• avoid unnecessary stress

fatigue management/energy conservation

• balance rest with activity

• plan ahead

• set priorities/eliminate unnecessary tasks

• pace yourself

• learn activity tolerance (optimal duration w/out extreme fatigue, pain, distress)

Arthritis Precautions

• respect pain

• avoid fatigue

• avoid stressing inflamed or unstable joints

• use resistive exercise or activity with caution

• be aware of sensory impairments

• be cautious with fragile skin due to systemic disease or medication side effects

OT interventions include:

therapeutic exercises and activities

• ROM, strengthening, endurance

PAMs

• hold and cold

splinting

• volar resting, wrist support, protective MCP, CMC stabilization

OT evaluation involves for RA/OA?

• client Hx

• occupational profile

• occupational performance

• cognitive, psychological, and social status

Reasons for splinting

to prevent, support, and correct

• reduce inflammation

• decrease pain

• preventing overstretching or shortening

• supporting unstable joints

• promoting rest in functional positions

• proper joint positioning

• immobilization

• limiting undesired motion

• increase ROM and strength

dynamic splint

• one or more resilient components that produce motion (elastic, rubber bands, springs)

• for increasing PROM

ex: spring-coil finger extension splint

static spint

• has no moveable components

• immobilizes a joint

• for resting or protection

• to reduce pain

• to prevent muscle shortening/contractures

ex: wrist cock up splint

immobilizing splint

• a type of supportive splint

• for resting and protection

• for position and facilitate proper healing after surgery

ex: thumb spica splint

corrective splint

• correct deformities

• assist and control movement

ex: dynamic ulnar deviation splint

Boutonniere deformity

flexion of the PIP, hyperextension of the DIP

ulnar deviation deformity

MCPS bend towards ulna

swan neck deformity

hyperextension of the PIP, flexion of the DIP

Purpose of PAMs

• to produce a response in soft tissue using light, water, temp., sounds, and electricity

• to prepare for activities

• used before or during functional activity to enhance OT interventions

Advanced practice of PAMs for California

can be performed by OT after 30 contact hours and 240 hours of supervised on-the-job training, clinical internship or affiliation. Must be competent to use.

Superficial PAMs

• cryotherapy

• cold/hot packs

• hydrotherapy

• ice

• fluidotherapy

• paraffin

• infrared

• water

deep thermal PAMs

• ultrasound

• phonophoresis

• iontophoresis

Purpose of Thermal Modality PAMs

• increase motion

• make scar tissue more extensible

• decrease joint stiffness

• relieve muscle spasms

• increase blood flow

• decrease pain

• aid in reabsorption of exudates (mass of cells that seeped out) and edema

praffin bath

conduction = transfer of heat from one object to another through direct contact

for: arthritis

hot packs

conduction

used when not able to submerge in paraffin due to location

fluidotherapy

convection = fluid motion around the tissues

finely ground corn husks particles circulate arms

warms and desensitizes tissue before activity

for: arthritis, carpal tunnel, tendonitis, post-op, raynaud syndrome

cryotherapy

use of cold temperature for vasoconstriction (decrease blood flow)

for: edema, cancer, active bleeding, cardiac insufficiency

ultrasound

conversion (heat is generated internally by friction)

apply gel and sound waves penetrate tissue, causing vibration (continuous or pulsed)

contrast baths

alternating cold and heat for vasodilationn and vasoconstriction

phonophoresis

use ultrasound to enhance delivery of topical drugs to enhance absorption

for: inflammation/pain

examples of electrical modalities

• TENS

• interferential

• H-wave

• Hi-volt

• Iontophoresis

• NMES

Uses for Electrical Modalities

• pain modulation

• muscle re-education

• edema reduction

• scar modalities

• increasing ROM

• facilitating healing

TENS (transcutaneous electrical nerve stimulation)

• to suppress pain by blocking pathways to CNS (electroanalgesia)

• 
  

Interferential

alternating current for pain modulation

similar to TENS but deeper penetration

H-wave

stimulates muscles and nerves by blocking nerve endings to promote circulation and relieve pain

Hi-volt

pulsing voltage for pain, edema, and wound healing (especially pressure ulcers)

Iontophresis

topically applied medication path with low voltage direct current

for: scar management (DC), pain modulation (AC)

NMES (neuromuscular electrical stimulation)

• used to increase muscle strength by stimulating peripheral nerves to achieve muscle contraction

• selectively stimulates large muscle fibers, unlike active motion with stimulates small muscle fibers

• for: increasing ROM, reduce atrophy, reduce edema

CVA

cerebrovascular accident

stroke

when blood flow to a part of the brain is stopped due to blockage or rupture of blood vessel

risk factors of CVA

• high blood pressure (hypertension)

• smoking

• high cholesterol

• obesity

• diabetes

warning signs of stroke

1. sudden numbness in arms, face, or leg

2.